| 1. |
- Lindqvist, Emma, et al.
(författare)
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Lymphedema after treatment for endometrial cancer - A review of prevalence and risk factors
- 2017
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Ingår i: European Journal of Obstetrics, Gynecology, and Reproductive Biology. - : ELSEVIER SCIENCE BV. - 0301-2115 .- 1872-7654. ; 211, s. 112-121
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Forskningsöversikt (refereegranskat)abstract
- Lymphedema is one of the least studied complications of cancer treatment and a chronic condition with a substantial impact on health-related quality of life (HQoL). Lymphedema of the legs (LLL) constitutes a common adverse side effect of lymphadenectomy LA in gynecologic cancer treatment. Primary treatment of endometrial cancer (EC) comprises hysterectomy and bilateral salpingo-oophorectomy. Pelvic and para-aortic lymphadenectomy is recommended in prognostic high risk groups of EC. This review summarizes the published literature concerning the prevalence of LLL after treatment for EC, methods used for measuring LLL, risk factors and HQoL impact. The main findings are that the reported prevalence of LLL varies significantly between 0% and 50%. This is due to a lack of a generally accepted standardization of terminology in assessment of lymphedema. The studies use different methods to assess and grade lymphedema and often the methodology used for determining LLL is poorly described and lacks baseline measurement. Lymphadenectomy, number of lymph nodes removed, and radiation therapy seems to increase the risk for LLL. All studies dealing with HQoL show that women with LLL have impaired HQoL. The level of evidence in the published studies is generally low. Consequently it is difficult to make clear-cut conclusions about the true prevalence or determination of risk factors. More prospective longitudinal or randomized trials with LLL as the primary outcome are necessary before conclusions can be drawn regarding prevalence of LLL and risk factor determination in EC. An internationally accepted standardization for terminology and methodology in lymphedema in research is needed. (C) 2017 Elsevier B.V. All rights reserved.
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| 2. |
- Wedin, Madelene, et al.
(författare)
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Impact of lymphadenectomy and lymphoedema on health-related quality of life 1 year after surgery for endometrial cancer. A prospective longitudinal multicentre study
- 2022
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Ingår i: Bjog-an International Journal of Obstetrics and Gynaecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 129:3, s. 450-460
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Tidskriftsartikel (refereegranskat)abstract
- Objective To assess the impact of lymphadenectomy and lymphoedema of the lower limbs (LLL) on health-related quality of life (HRQoL) 1 year after surgery for endometrial cancer (EC). Design Prospective longitudinal cohort multicentre study. Setting Departments of obstetrics and gynaecology at four university hospitals, six central hospitals and four county hospitals in Sweden. Population Two-hundred-and-thirty-five women with early stage EC were included; 116 with high-risk EC underwent surgery including lymphadenectomy (+LA), and 119 with low-risk EC had surgery without lymphadenectomy (-LA). Methods The generic SF-36 and EQ-5D-3L and the lymphoedema-specific LYMQOL questionnaire were used to assess HRQoL. LLL was assessed by systematic circumferential measurements of the legs enabling volume estimation, clinical evaluation and patient-reported perception of leg swelling. All assessments were carried out on four occasions; preoperatively, and 4-6 weeks, 6 months and 1 year postoperatively. Main outcome measure HRQoL scores. Results No significant differences were seen in HRQoL between the +LA and -LA groups 1 year postoperatively. Irrespective of method of determining LLL, women with LLL were significantly more affected in the LYMQOL domains Function, Appearance/body image and Physical symptoms, but not in the domain Emotion/mood, than women without LLL. No such differences were seen in the generic HRQoL or in the LYMQOL global score between the groups with and without LLL. Conclusions Lymphadenectomy did not seem to affect generic HRQoL adversely. Irrespective of the method of measuring, LLL affected the lymphoedema-specific HRQoL negatively, mainly in physical domains, but had no impact on the generic HRQoL. Tweetable abstract Lymphoedema has impact on lymphoedema-specific, but not on generic, HRQoL, 1 year after surgery for EC.
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| 3. |
- Wedin, Madelene, et al.
(författare)
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Incidence of lymphedema in the lower limbs and lymphocyst formation within one year of surgery for endometrial cancer: A prospective longitudinal multicenter study
- 2020
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Ingår i: Gynecologic Oncology. - : Elsevier BV. - 0090-8258 .- 1095-6859. ; 159:1, s. 201-208
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Tidskriftsartikel (refereegranskat)abstract
- Objective. The study aimed to determine the incidence of lower limb lymphedema (LLL) after surgery for endometrial cancer (EC) by means of three methods, and to determine the incidence of lymphocysts after one year. Methods. A prospective longitudinal multicenter study was conducted in 14 hospitals in Sweden. Two-hundred-and-thirty-five women with EC were included; 116 underwent surgery that included lymphadenectomy (+LA) and 119 were without lymphadenectomy ( -LA). Lymphedema was assessed objectively on four occasions; preoperatively, at 4-6 weeks, six months and one year postoperatively using systematic measurement of leg circumferences, enabling calculation of leg volumes, and a clinical grading of LLL, and subjectively by the patient's perception of lymphedema measured by a lymphedema-specific quality-of-life instrument. Lymphocyst was evaluated by vaginal ultrasonography. Results. After one year the incidence of LLL after increase in leg volume adjusted for body mass index was 15.8% in +LA women and 3.4% in -IA women. The corresponding figures for clinical grading were 24.1% and 11.8%, and for patient-reported perceived LLL 10.7% and 5.1%. The agreement between the modalities revealed fair to moderate correlation between patient-reported LLL and clinical grading, but poor agreement between volume increase and patient-reported LLL or clinical grading. Lymphocysts were found in 43% after one year. Conclusions. Although the incidence of ILL and lymphocysts after surgery for EC including LA seemed to be relatively high the study demonstrated significant variations in incidence depending on the measurement modality. This emphasizes the need for a 'gold standard' of measurement of LLL in clinical practice and research. (C) 2020 Elsevier Inc. All rights reserved.
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| 4. |
- Wedin, Madelene, 1976-
(författare)
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On lymphedema of the lower limbs after treatment of endometrial cancer : with emphasis on incidence, quality of life, risk factors, and health economy
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Objectives: The overall purpose of this study was to investigate the long-term consequences of primary surgical treatment of endometrial cancer with emphasis on lymphadenectomy, lymphedema development in the limbs, health-related quality of life, and health economy aspects. The primary objective was to assess the incidence of lymphedema both objectively and subjectively by using three different methods to determine lymphedema. Secondary objectives were to determine risk factors for lymphedema, and to analyze the impact of lymphadenectomy and lymphedema on health-related quality of life. Another secondary objective was to evaluate the hospital costs of lymphadenectomy and lymphedema one year after primary treatment of endometrial cancer.Material and methods: The study was a prospective observational longitudinal multicenter study with 15 Swedish hospitals participating between June 2014 and January 2018. Two hundred sixty-two women with presumed early stage endometrial cancer were included; 235 women completed the study. Of these, 119 were classified as having high-risk endometrial cancer and underwent surgery including lymphadenectomy, and 116 were classified as having low-risk endometrial cancer where no lymphadenectomy was performed. The women were evaluated preoperatively according to the national guidelines for endometrial cancer. The women were all monitored on four occasions: preoperatively, then four to six weeks, six months, and one year postoperatively. On all occasions, lymphedema was evaluated by means of two objective methods: systematic circumferential measurements of the lower limbs, enabling estimation of the leg volume, and by clinical grading of lymphedema of the lower limbs, and subjectively by means of the patient-reported perception of leg swelling. Health-related quality of life was evaluated using three different quality of life questionnaires. Two were generic: the SF-36 and EQ-5D-3L, and one was lymphedema-specific: the LYMQOL. Intraabdominal lymphocysts were evaluated by transvaginal ultrasound. Cost analysis of hospital costs was performed in relation to lymphadenectomy and lymphedema development.Results: The incidence of lymphedema varied between 9.5% and 29.6%, depending on the method of assessment of lymphedema. The highest incidence was found when using patient-reported swelling. The incidences of lymphedema were significantly higher in the lymphadenectomy group (14.9% - 38.1%) compared with the non-lymphadenectomy group (3.4% - 21.4%). The inter-rater agreement of lymphedema between the various methods of determining lymphedema was low. The incidence of lymphocysts was 4.3% and did not seem to pose a clinical problem. Lymphadenectomy per se did not seem to affect health-related quality of life negatively; however, lymphedema, independent of the method of assessing lymphedema, affected the lymphedema-specific quality of life significantly negatively, mainly in physical domains. Lymphadenectomy, age, and adjuvant radiation therapy were independent risk factors for lymphedema. Lymphadenectomy generated higher hospital costs, independent of the mode of surgery.Conclusions: A significant number of women develop lymphedema after lymphadenectomy in the treatment of endometrial cancer. The incidences vary, depending on the method of determining lymphedema. This inconsistency is also reflected in risk factors for lymphedema. Lymphadenectomy, increasing age, and adjuvant radiation are factors to pay attention to when planning treatment of endometrial cancer, not least because lymphedema has a negative impact on health-related quality of life. Lymphadenectomy is a cost-driving procedure and its use should be carefully evaluated in relation to its potential benefits.
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| 5. |
- Wedin, Madelene, 1976-, et al.
(författare)
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Risk factors for lymphedema and method of assessment in endometrial cancer: a prospective longitudinal multicenter study
- 2021
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Ingår i: International Journal of Gynecological Cancer. - : BMJ. - 1048-891X .- 1525-1438. ; 31:11, s. 1416-1427
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Tidskriftsartikel (refereegranskat)abstract
- Objective The aim of the study was to determine risk factors for lymphedema of the lower limbs, assessed by four methods, 1 year after surgery for endometrial cancer. Methods A prospective longitudinal multicenter study was conducted in 14 Swedish hospitals. 235 women with endometrial cancer were included; 116 underwent surgery including lymphadenectomy, and 119 had surgery without lymphadenectomy. Lymphedema was assessed preoperatively and 1 year postoperatively objectively by systematic circumferential measurements of the legs, enabling volume estimation addressed as (1) crude volume and (2) body mass index-standardized volume, or (3) clinical grading, and (4) subjectively by patient-reported perception of leg swelling. In volume estimation, lymphedema was defined as a volume increase >= 10%. Risk factors were analyzed using forward stepwise logistic regression models and presented as adjusted odds ratio (aOR) and 95% confidence interval (95% CI). Results Risk factors varied substantially, depending on the method of determining lymphedema. Lymphadenectomy was a risk factor for lymphedema when assessed by body mass index-standardized volume (aOR 14.42, 95% CI 3.49 to 59.62), clinical grading (aOR 2.11, 95% CI 1.04 to 4.29), and patient-perceived swelling (aOR 2.51, 95% CI 1.33 to 4.73), but not when evaluated by crude volume. Adjuvant radiotherapy was only a risk factor for lymphedema when assessed by body mass index-standardized volume (aOR 15.02, 95% CI 2.34 to 96.57). Aging was a risk factor for lymphedema when assessed by body mass index-standardized volume (aOR 1.07, 95% CI 1.00 to 1.15) and patient-perceived swelling (aOR 1.06, 95% CI 1.02 to 1.10), but not when assessed by crude volume or clinical grading. Increase in body mass index was a risk factor for lymphedema when estimated by crude volume (aOR 1.92, 95% CI 1.36 to 2.71) and patient-perceived swelling (aOR 1.36, 95% CI 1.11 to 1.66), but not by body mass index-standardized volume or clinical grading. The extent of lymphadenectomy was strongly predictive for the development of lymphedema when assessed by body mass index-standardized volume and patient-perceived swelling, but not by crude volume or clinical grading. Conclusion Apparent risk factors for lymphedema differed considerably depending on the method used to determine lymphedema. This highlights the need for a 'gold standard' method when addressing lymphedema for determining risk factors.
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| 6. |
- Wedin, Madelene, et al.
(författare)
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Validation of the Lymphoedema Quality of Life Questionnaire (LYMQOL) in Swedish cancer patients
- 2020
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Ingår i: Acta Oncologica. - : Taylor & Francis. - 0284-186X .- 1651-226X. ; 59:3, s. 365-371
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Tidskriftsartikel (refereegranskat)abstract
- Background: The aim of this study was to validate a translated Swedish version of the lymphoedema-specific quality of life questionnaire (LYMQOL) in a cohort of Swedish cancer patients with secondary lymphoedema of the limbs after cancer treatment.Material and methods: We recruited 102 patients with lymphoedema of the arms or legs after cancer treatment who were visiting lymphoedema therapists at the departments of oncology at the university hospitals in Linköping and Umeå. The LYMQOL questionnaires were translated forward and backward from English to Swedish. Content and face validity were evaluated. The construct validity was assessed by comparing the LYMQOL with the Short Form Health Survey (SF-36) and the perceived degree of lymphoedema of the limbs, respectively. Reliability was determined through test-retest. The internal consistency was assessed by determining Cronbach’s alpha and by factor analysis.Results: The content and face validity assessments showed that LYMQOL was an easy, clear and not too long questionnaire to use for patients with lymphoedema. Construct validity was high in both versions when compared with the SF-36. The association between the degrees of perceived lymphoedema and the LYMQOL was only significant in the domains Function and Body Image in the arm version, whereas all domains in the leg version were significant. The reliability was good for the arm version (intra-class-correlation coefficients 0.53–0.87) and very good for the leg version (intra-class-correlation coefficients 0.78–0.90). The internal consistency was acceptable to excellent, with Cronbach’s alpha values between 0.79–0.93 (arm-version) and 0.87–0.94 (leg-version). The factor analysis confirmed the usefulness of the four domains in the LYMQOL versions.Conclusions: This study confirmed the validity of the Swedish version of LYMQOL and demonstrated that LYMQOL may be a simple and useful tool for use in clinical practice and scientific contexts for evaluating QoL in patients with lymphoedema of the limbs.
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